Provider Demographics
NPI:1013565704
Name:MARTINEZ, JAMES (LCADC, CCS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 ROUTE 130 APT 49C
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-2645
Mailing Address - Country:US
Mailing Address - Phone:908-937-7010
Mailing Address - Fax:
Practice Address - Street 1:3001 ROUTE 130 APT 49C
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-2645
Practice Address - Country:US
Practice Address - Phone:908-937-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00259200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)